Pulsed Doppler evaluation of left ventricular filling in stable and borderline juvenile arterial hypertension

Left ventricular hypertrophy in hypertensive patients may be associated with changes in diastolic function. To examine whether or not any alteration in left ventricular function is also present in the early phases of hypertension, left ventricular filling was studied using the echo-Doppler method in 30 young mild hypertensive patients, 40 borderline untreated hypertensives and 30 age-matched normotensive controls. Left ventricular wall thickness, left ventricular mass (Dévereux formula) and shortening fraction were measured using M-mode echocardiogram under 2D control. Trans-mitral flow was measured by pulsed-Doppler and the following parameters were derived: peak early (E) and atrial (A) diastolic flow rate, their ratio E/A, the integral of early (Ei) and atrial (Ai) diastolic flow rates and their ratio (Ei/Ai). Our data show that left ventricular mass is greater in mild hypertensive patients than in borderline and normal controls. No differences in left ventricular systolic function were found in the three groups whereas diastolic function changes were present in the hypertensive group: in particular the peak early/atrial flow rate ratio was significantly reduced compared with the other two groups. Therefore, it appears that changes in diastolic function may also be present even in the early phases of mild hypertension